Sri Lanka’s labour force has tripled in recent years with the ratio of male and female workers now almost equal, and females predominating in certain areas of employment.
It is to be expected thus that on the job injuries at workplaces are also likely to surge affecting the health of the worker, which if not given adequate and timely attention could leave life long scars. Young people who comprise the majority of the workforce are most at risk.
Cuts, crush injuries, injuries from falls, wounds caused by machines have put the Lankan workers’ health on line with injuries to the eye and mental trauma considered significant and emerging issues. To identify the pattern of work injuries more accurately, the Health Ministry has now introduced an injury surveillance system which is currently being pilot tested.
Consultant Community Physician, Environmental and Occupational Health Directorate, Dr Inoka Suraweera shared with the Sunday Observer, the nature of these injuries, and the Health Ministry’s inputs with regard to both, the curative and preventive aspects.
Excerpts…
Q. On the job injuries at workplaces are increasing by the day. These injuries affect both males and females at factories, construction sites, when driving heavy trucks, or engaged in hazardous work. What are the most common injuries you see among the Lankan workforce?
A. Injuries range from non fatal to fatal. However, non fatal ones predominate. Cut and crush injuries among agricultural workers, injuries due to fall from heights at work, injuries due to machinery usage at workplaces are more prevalent. On the other hand, eye injuries due to welding, and other manufacturing processes are a significant issue.
There have been a number of fatalities in the recent past from work related accidents needing significant attention. However, the pattern of injuries mentioned here is based on individual surveys, mainly. The Ministry of Health has introduced an injury surveillance system which has been pilot tested. Once the surveillance system is in operation we will be able to identify the pattern of work injuries accurately.
Q. Some jobs require repetitive motions leading to cumulative trauma from repetitive injury by either overuse of the limb concerned or trying out new physical activities like, lifting weights etc. too quickly without proper preparation or warming up. What are these activities that lead to carpel tunnel syndrome, back sprain, etc? Explain the nature of the injuries and how they are caused.
A. Carpal tunnel syndrome is often the result of a combination of factors that reduce the available space for the median nerve within the carpal tunnel, rather than a problem with the nerve itself. Contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; an overactive pituitary gland; an underactive thyroid gland; and rheumatoid arthritis. Mechanical problems in the wrist joint, work stress, repeated use of vibrating hand tools may contribute to the compression. Often, no single cause can be identified.
The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but is especially, common in those performing assembly line work - manufacturing, sewing, cleaning, and meat, poultry, or fish packing. In fact, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel.
Q. Is cumulative trauma preventable?
A. Yes, with precautions.
Q. Can the symptoms be detected early ? Or do they start off being mild and get worse over time?
A. Yes. It is important to identify these issues initially.
Q. What are the most significant physical impacts that can occur?
A. Usually, workers get musculoskeletal disorders. These will not kill workers but, would certainly give rise to a lot of physical as well as mental agony, resulting in productivity loss at work and absenteeism. Long hours of sitting down can predispose the workers to non communicable diseases.
Q. Apart from non communicable physical disability can a person develop infectious diseases, like TB and pneumonia, when inhaling dust from coconut based industries?
A. Workers in dusty environments can develop respiratory health problems such as, Asthma and other chronic respiratory diseases. Silicosis, Asbestosis, lung fibrosis can occur due to special types of dusts.
Exposure to indoor air pollution with particulate matter, especially, PM2.5 can predispose workers for premature cardiovascular morbidity and mortality, stroke, lung cancers and chronic respiratory diseases.
Q. Recently, several persons died due to inhaling toxic fumes from a faulty waste water filling pipe . Other such incidents have also been recorded some years ago. What is the specific health impact of inhaling toxic fumes of any kind, especially, those mixed with chemicals, into the lungs?
A. The health effects will depend on the chemical inhaled. No generalized answer can be given.
Q. Do you have a national registry on the number of people in our labour force? It is said the number of males and females are equal with females dominating males in certain jobs like tea plucking, but many of them are in the informal sector. Are there plans to do an island wide survey to obtain details of the exact number of people engaged in the informal sector?
A. . Annual Labour Force survey done by the Department of Census and Statistics carry data on the labour force in Sri Lanka.
Q. Child labour is prohibited in Sri Lanka but the fact is, many children still work illegally, hired to mudalalis and boutique owners by their parents or in their own family businesses like sand, gem mining, etc. What is the health impact of such labour on a child’s still growing body?
A. Sri Lanka has drafted a child labour elimination policy. Children from 14 years up to 18 are not allowed to be engaged in hazardous work which again has been identified by law. Child labour can cause physical as well as mental trauma to the child engaged in labour,besides depriving them of their right to education.
Q. Insufficient legal safeguards for factory and other workers is said to be the reason behind the soaring number of workplace related accidents. Do you agree?
A. The current legislation does not cover all categories of workers. There are inadequacies in the monitoring of safety in workplaces.
Q. What are the most recently amended laws? Who enforces them?
A. The Ministry of Labour has the legal authority. However, the Health Ministry is mandated to look after all citizens in Sri Lanka and so are the workers. Work plays a central role in people’s lives, since most workers spend at least eight hours a day in the workplace. Therefore, work environments should be safe and healthy. Every day, workers everywhere face health hazards, such as: Chemical hazards, Physical hazards such as noise, vibration, Biological hazards, Ergonomical hazards, Psychological impacts. Hazardous working conditions also give rise to occupational diseases such as, lung diseases, cancers, and skin diseases. New hazards such as, occupational mental health issues too are becoming important than ever before. The Health Ministry is responsible for looking after their health and reducing their injuries at work.
Q. Who looks after the health of the informal sector?
A. Looking after the health of informal sector workers is a challenge, yet, we can face it as we have good public health infrastructure and can address the issues through that system. It is important however, that all stakeholders join hands to achieve these objectives. While the Labour Ministry is a major stakeholder, the Health Ministry is a key player too. Provision of occupational health and safety for workers in a country is always teamwork. There should be a constant dialogue between the Ministry of Labour and Ministry of Health with other relevant stakeholders to identify strategies to improve occupational health and safety of our workers.
The Directorate of Environmental and Occupational Health runs the National Occupational Health Program of the Health Ministry. The latter provides curative (treatment), rehabilitative, preventive and promotive health services for workers.
Q. What are your guidelines on achieving those goals?
A. The Sustainable Development Goals provide useful directions for action on protecting and promoting workers’ health. These include, social protection of victims of occupational diseases and injuries (SDG1), prevention and management of NCDs at workplace, extending universal health coverage and improving health and safety of workers in the informal economy and migrants, protecting occupational health and safety of health workers and rapid response teams (SDG3), elimination of hazardous child labour, safe and healthy working environment for all workers, particularly, women, migrants and workers in precarious employment (SDG8) and addressing the effects of climate change and environmental pollution on the health of workers .
Q. I understand you have a National Occupational Health Program. Tell us briefly about it.
A. The National Occupational Health Program targets all workers in all work places in Sri Lanka. The target population is 7.8 million workers both in the formal (40%) and informal sectors (60%). The aim of the program is developing a healthy workforce who can contribute to sustainable development of Sri Lanka. The objectives of the program are to:
promote and maintain the highest degree of health among workers
preventadverse effects on health (hazards) caused by the working conditions
protect workers in their employment from risks resulting from factors adverse to health
adapt thework environment to workers
The National Occupational Health Program has been redesigned to consider the overall health of workers. This includes addressing injuries, non communicable diseases, communicable diseases and mental health issues. All workers in Sri Lanka have access to free health services at the curative as well as preventive health sectors. Treatment of occupational diseases and injuries and rehabilitation of occupational injuries are integrated into the existing curative health system. Occupational medical problems are taken care of by the medical units, occupational surgical problems by the surgical units and rehabilitation by the physiotherapy and rehabilitation units. Occupational accidents affecting significant number of workers and surrounding communities are considered as disasters and curative sector response is carried out immediately.
Q. How are these activities implemented?
A. Implementing occupational health activities in the preventive health sector is mainly through the MOH offices. The Medical Officers of Health (MOOH) and the Public Health Inspectors (PHII) carry out occupational health activities at grassroots level. The MOOH and PHII are expected to visit workplaces and identify health issues resulting from hazards in the work environment, advice on preventive and protective remedial measures, carry out activities to promote overall health of the workers, workers’ health surveillance and advice on basic facilities such as, safe drinking water, sanitary latrines, meal and changing rooms, adequate washing facilities and first aid facilities at workplaces.
The Environmental and Occupational Health Directorate of the Health Ministry conducts capacity building on occupational health and safety, for Medical Officers of Health, Additional Medical Officers of Health, Public Health Inspectors and other categories of health staff. They in turn provide services for the workers.
Q. The ILO campaign for the 2018 World Day for Safety and Health at work focused on improving the safety and health of young workers. Why?
A. Because they are at higher risk of getting hurt at workplaces, since they like taking risks. Apart from that they have many Reproductive health issues that arise from and can impact on their work.